Drug-induced acne and rose pearl: similarities

Abstract

Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.

Drug-induced acne, or drug-induced acneiform eruption, is an adverse effect of a series of systemic drugs, such as corticosteroids, lithium, vitamin B12, thyroid hormones, halogen compounds (iodine, bromine, fluorine, and chlorine), antibiotics (tetracycline and streptomycin), antituberculosis drugs (INH), lithium carbonate, antiepileptic drugs (phenobarbital and hydantoin derivatives), cyclosporin A, antimycotics, gold salts, isotretinoin, clofazimine, epidermal growth factor receptor inhibitors (cetuximab, gefitinib, and erlotinib), and interferon-beta.^1,2 Usually, topical products such as cosmetics may lead to acneiform eruption in women, especially in the region of the chin.² Intravenous dexamethasone and high doses of oral corticosteroids often induce typical acneiform eruptions, with lesions predominantly located on the chest and back.¹

Clinically, it is characterized by a sudden monomorphic eruption of inflammatory papules and pustules, usually pruritic and follicular.^1,2,3 Punctiform vesicles occasionally appear in the center of papules, which may develop into small vesicopustules.^2,3 An important clinical aspect in the differential diagnosis of drug-induced acne is the fact that the skin lesions are not preceded by visible comedones.⁴

Discontinuation of the drug leads to remission of symptoms. Antihistamines are recommended in case of pruritus, and oral antibiotics are recommended in case of secondary infection with pustules or impetiginization.^2,3

We can observe the usual aspect of a papular follicular eruption and, on closer look, a small papule carefully surmounted by a pustule, which might be a possible evolution into a vesiculopustule, as cited in the literature, demonstrating the inexorable aspect of drug-induced acne (Figure 1). We highlight the absence of comedones, which supports the diagnosis (Figures 2 and 3).

FIGURE 1.

Small papule carefully surmounted by a pustule

FIGURE 2.

Small papules and pustules are observed as well as the absence of comedones

FIGURE 3.

Inflammatory papules and pustules located in the anterior trunk

The male patient reported an insect bite in the area of the anterior trunk and use of a cream containing a combination of an antifungal agent, corticosteroid, and a topical antibiotic, with progressive worsening of the lesion in 10 days and intense pruritus. We opted for discontinuing the topical medication and prescribed a combination of clindamycin and benzoyl peroxide, obtaining total control of the condition in 14 days. Important differential diagnosis includes pityrosporum folliculitis (Malassezia), which presents similar follicular papules and pustules. However, in spite of the treatment recommended in the literature, that is, topical and oral antifungal drugs, we observe slow healing and frequent recurrences. Moreover, the use of topical antibiotics brings no benefits, as reported above.

The nature of the lesions, with a pinkish erythematous aspect, resembles a rose pearl, highly used by ladies as a bead in necklaces and bracelets; however, in this case, without its adornment function (Figure 4).⁵

FIGURA 4.

Rose pearls, used as beads in adornments